Bio: Joshua Sumankuuro is an academic researcher from Charles Sturt University. The author has contributed to research in topics: Health care & Medicine. The author has an hindex of 8, co-authored 16 publications receiving 147 citations. Previous affiliations of Joshua Sumankuuro include University of the Witwatersrand & Philippine Institute for Development Studies.
TL;DR: Examination of health system factors impacting on access to and delivery of quality maternal and newborn healthcare in rural settings in Ghana shows significant barriers affecting the quality and appropriateness of maternal and neonatal health services in the rural communities and the Nadowli District Hospital.
Abstract: Objectives In considering explanations for poor maternal and newborn health outcomes, many investigations have focused on the decision-making patterns and actions of expectant mothers and families, as opposed to exploring the ‘supply side’ (health service provider) barriers. Thus, we examined the health system factors impacting on access to and delivery of quality maternal and newborn healthcare in rural settings. Design A semistructured qualitative study using face-to-face in-depth interviews with health professionals, and focus group sessions with community members, in eight project sites in two districts of Upper West Region, Ghana, was employed. Participants were purposively selected to generate relevant data to help address the study objective. The survey was guided by WHO standard procedures and Ghana Health Ministry’s operational work plan for maternal and newborn care. Setting Nadowli–Kaleo and Daffiama–Bussie–Issa districts in Upper West Region, Ghana. Participants Two hundred and fifty-three participants were engaged in the study through convenient and purposive sampling: healthcare professionals (pharmacist, medical doctor, two district directors of health services, midwives, community health and enrolled nurses) (n=13) and community members comprising opinion leaders, youth leaders and adult non-pregnant women (n=240 in 24 units of focus groups). Results Results show significant barriers affecting the quality and appropriateness of maternal and neonatal health services in the rural communities and the Nadowli District Hospital. The obstacles were inadequate medical equipment and essential medicines, infrastructural challenges, shortage of skilled staff, high informal costs of essential medicines and general limited capacities to provide care. Conclusion Implementation of the birth preparedness and complication readiness strategy is in its infancy at the health facility level in the study areas. Increasing the resources at the health provider level is essential to achieving international targets for maternal and neonatal health outcomes and for bridging inequities in access to essential maternal and newborn healthcare.
TL;DR: The study explores rural community-level barriers to seeking care related to obstetric complications and delivery from the perspectives of mothers, youth, opinion leaders and healthcare providers in Nadowli-Kaleo and Daffiama-Bussie-Issa districts in the Upper West Region of Ghana and concludes that this is primarily a cultural issue.
Abstract: Despite the many maternal healthcare policy programmes in Ghana such as free the antenatal care (ANC) and the fee-exemption policy under the National Health Insurance Scheme, among others, the country has yet to make substantial improvements in addressing low skilled care utilisation in pregnancy and delivery. From previous studies, maternal mortality has been linked to women’s healthcare decision-making power at the household level in many low and middle-income countries. Thus, a pregnant women’s ability to choose a healthcare provider, act on her preferences, and to be sufficiently financially empowered to take the lead in deciding on reproductive and pregnancy care has significant effects on service utilisation outcomes. Therefore, we explored rural community-level barriers to seeking care related to obstetric complications and delivery from the perspectives of mothers, youth, opinion leaders and healthcare providers in Nadowli-Kaleo and Daffiama-Bussie-Issa districts in the Upper West Region of Ghana. This exploratory qualitative study was based on the narratives of women, health providers and community stakeholders regarding the expectant women’s autonomy to decide and utilise maternal care. To achieve maximal diversity of responses, purposive sampling procedures were followed in selecting 16 health professionals, three traditional birth attendants and 240 community members (opinion leaders, youth and non-pregnant women) who participated in individual depth interviews and focus group discussions. Women’s lack of autonomy to seek care without prior permission, perceived quality care of traditional birth attendants, stigmatisation of unplanned pregnancies and cultural beliefs associated with late disclosure of childbirth labour all delayed mothers timely use of skilled care in the study communities. These barriers compounded problems arising from communities that are geographically isolated from hospital care. Decisions about seeking maternal care were usually made by the expectant woman’s husband and family without providing adequate support to pregnant women during the latter stages of pregnancy and delivery. We conclude that this is primarily a cultural issue. The study recommends a change in the approach to community-level health education campaigns for maximum impacts through the increased involvement of men and families in health service delivery and utilisation.
TL;DR: Findings provide focused targets and open a window of opportunity for the community-based health services run by Ghana Health Service to intensify health education and promotion programmes directed at reducing risky economic activities and other cultural beliefs and practices affecting maternal and neonatal morbidity and mortality.
Abstract: Background Maternal and neonatal morbidities and mortalities have received much attention over the years in sub-Saharan Africa; yet addressing them remains a profound challenge, no more so than in the nation of Ghana. This study focuses on finding explanations to the conditions which lead to maternal and neonatal morbidities and mortalities in rural Ghana, particularly the Upper West Region. Method Mixed methods approach was adopted to investigate the medical and non-medical causes of maternal and neonatal morbidities and mortalities in two rural districts of the Upper West Region of Ghana. Survey questionnaires, in-depth interviews and focus group discussions were employed to collect data from: a) 80 expectant mothers (who were in their second and third trimesters, excluding those in their ninth month), b) 240 community residents and c) 13 healthcare providers (2 district directors of health services, 8 heads of health facilities and 3 nurses). Result Morbidity and mortality during pregnancy is attributed to direct causes such urinary tract infection (48%), hypertensive disorders (4%), mental health conditions (7%), nausea (4%) and indirect related sicknesses such as anaemia (11%), malaria, HIV/AIDS, oedema and hepatitis B (26%). Socioeconomic and cultural factors are identified as significant underlying causes of these complications and to morbidity and mortality during labour and the postnatal period. Birth asphyxia and traditional beliefs and practices were major causes of neonatal deaths. Conclusion These findings provide focused targets and open a window of opportunity for the community-based health services run by Ghana Health Service to intensify health education and promotion programmes directed at reducing risky economic activities and other cultural beliefs and practices affecting maternal and neonatal morbidity and mortality.
TL;DR: Greater understanding of the sociocultural barriers to ANC is essential if proposed changes in community-specific health education programs are to facilitate early commencement and increased use of ANC.
Abstract: Background Despite decades of implementation of maternity healthcare programmes, including a focus on increasing the use of antenatal care (ANC) and concomitant birth preparedness and complication readiness (BPCR), the uptake of ANC continues to be below expectations in many developing countries. This has attendant implications for maternal and infant morbidity and mortality rates. Known barriers to ANC use include cost, distance to health care services and forces of various socio-cultural beliefs and practices. As part of a larger study on BPCR in rural Ghana, this paper reflects on the use of ANC in the study areas from rights-based and maternal engagement theoretical perspectives, with a focus on the barriers to ANC use. Methods Mixed methods approach was adopted to collect data from 8 study communities from individual in-depth interviews with 80 expectant mothers and 13 health care professionals, and 24 focus groups comprising 240 community members. The qualitative data followed a thematic analytical method, while the quantitative data was analysed using descriptive statistics. Results The average number of ANC visits were 3.34±1.292, and the majority of expectant mothers (71.3%) enrolled for ANC at the 8th week or later, with the longest delay recorded at the 6th month of gestation. Traditional norms significantly influenced this delay. Likewise, overall use of ANC during pregnancy was shaped by cultural factors related to perceptions of pregnancy, gender-based roles and responsibilities and concerns that ANC would result in an overweighed baby and culturally inappropriate delivery at a health care facility. Conclusion Greater understanding of the sociocultural barriers to ANC is essential if proposed changes in community-specific health education programs are to facilitate early commencement and increased use of ANC.
TL;DR: Cultural beliefs and practices related to maternal and neonatal health care are intergenerational and intensive community-specific education strategies to facilitate behaviour changes are required for improved MNH outcomes.
01 Jan 2012
TL;DR: The questionnaires from the field were received, checked and stored by the data processing personnel and checked the completeness of the questionnaires and the correct bubbling.
Abstract: The questionnaires from the field were received, checked and stored by the data processing personnel. They checked: 1. The completeness of the questionnaires 2. The correct bubbling 3. The correct number of questionnaires per household, if total males + total females > 8 as the questionnaire ONLY accommodated maximum of 8 household members. 4. The reference number appears in all the 10 pages of the questionnaires.
TL;DR: A new release of a book published 10 years ago by the National League for Nursing, Madeleine M. Leininger's culture care theory does not fit well with existing thinking on theory development approaches, and that theories in nursing have been conceptualized within the logical positivist and quantitative paradigm.
Abstract: Culture Care Diversity and Universality: A Theory of Nursing edited by Madeleine M. Leininger, PhD, RN, FAAN; Sudbury, MA: Jones and Bartlett, 2001; 448 pages, $34.95 This new release of a book published 10 years ago by the National League for Nursing is said to be the definitive and comprehensive source for Leininger's culture care theory. It is presented in three parts: Part I is a description of the theory and its underpinnings by Leininger. Part II, in nine chapters, describes the research method to study culture care, by Leininger, followed by research by various authors who have used the theory and method. Part III, in three chapters, all by Leininger, focuses on findings from research that have used the theory and the method and use of the theory in education and administration. A final chapter addresses the relevance of the culture care theory in projecting the future of nursing. The reissue of this book is both timely and welcome. Leininger has almost single-handedly transformed our thinking about the need for culture care in all domains, whether it be in nursing care, in educational programs, or administration of patient care services. As our country has become more and more multicultural, and as we have come to see the impact of events in other parts of the world on our daily lives, the theory of "culture care diversity and universality" assumes an importance not previously felt or understood. The author makes some attempt to place her culture care theory within the framework of the broader theory development enterprise in nursing and the different approaches used to develop theory. She concludes that culture care theory does not fit well with existing thinking on theory development approaches, and that theories in nursing have been conceptualized within the logical positivist and quantitative paradigm. Culture care theory, on the other hand, was "conceptualized within the qualitative discovery paradigm with largely inductive emic (people-centered) views and not from the researcher's a priori hypotheses" (p. 24). The central issue of concern to this reviewer is not with the utility and elegance of this theory, for it has both. It is rather, that it claims too much for itself and does not recognize the place, utility, co-existence, or indeed, complementarity, of other theoretical approaches, especially if they are developed within the positivist paradigm, and worse yet, if they demand quantitative approaches for verification of hypotheses derived from them. The book appears to claim that culture care theory and knowledge are sufficient to address all dimensions of nursing. …
01 Jan 2016
28 Oct 2015
TL;DR: Community and health-care provider attitudes towards maltreatment during delivery in rural northern Ghana are explored, and findings against The White Ribbon Alliance's seven fundamental rights of childbearing women are compared.
Abstract: Maltraitance pendant l'accouchement: interview individuels ou en groupe aupres d'habitants et de professionnels de soins. Les mauvais traitements sont evoques spontanement et parmi tous les types d'interviewe, ce qui suggere que le probleme n'est pas inhabituel et que cela peut dissuader les femmes d'aller accoucher en milieu hospitalier (Nord du Ghana)
TL;DR: The findings show that the most important barriers to maternal health are transportation barriers to health facilities, economic factors, and cultural beliefs, in addition to lack of family support and poor quality of care.
Abstract: The new Sustainable Development Goals (SDGs) to 2030 aim to reduce maternal mortality and provide equitable access to maternal healthcare. Compromised access to maternal health facilities in low-income countries, and specifically in Africa, contribute to the increased prevalence of maternal mortality. We conducted a systematic review to investigate access barriers to maternal health in low-income countries in Africa since 2015, from the perspective of both community members and health providers. The findings show that the most important barriers to maternal health are transportation barriers to health facilities, economic factors, and cultural beliefs, in addition to lack of family support and poor quality of care. Further research is required to guide policymakers towards firm multi-sectoral action to ensure appropriate and equitable access to maternal health in line with the SDGs to 2030.